Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert

Abstract

Purpose: To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA^®), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops.

Patients and methods: This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents.

Results: Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications.

Conclusion: Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.

Keywords: hands-free therapy; intracanalicular dexamethasone insert; ocular inflammation; ocular pain; phacoemulsification; sustained-release drug delivery.

Figure 1

Dexamethasone intracanalicular insert depicted in yellow (coin for scale) (A). Placement of the dexamethasone intracanalicular insert in the canaliculus of the eye (B). The dexamethasone intracanalicular insert can be visualized by a blue light source (for example, slit lamp or hand-held blue light) with a yellow filter (C).

Figure 2

Proportion of patients reporting (A) prescribed schedule and (B) proper instillation of eyedrops combined with DEX after cataract surgery. More than 38% of patients reported that it was difficult to take all eyedrops exactly when they were supposed to be applied (A), and more than 40% of patients reported that it was difficult to apply all eye drops exactly into their eye every time (B).

Figure 3

Proportion of patients who reported missing instillation of prescribed eyedrops combined with DEX after cataract surgery. Patients reported missing at least 1 eyedrop instillation of prescribed eyedrops after surgery.

Figure 4

(A) Satisfaction, (B), preference, and (C) likelihood of recommending DEX to family members of patients at 30 days from DEX placement. (A) and (C) were scored on a 7-point Likert scale and (B) was a multiple-choice question. Patients were generally satisfied with having DEXTENZA during cataract surgery (A), would prefer DEXTENZA over 4 additional eye drops per day (B), and were likely to recommend DEXTENZA to a family member for post-cataract surgery pain control (C).

Figure 5

Proportion of practice staff representatives who reported patients having difficulty with a type of ocular medication. Patients more frequently had difficulty with steroid medications compared to NSAIDs or antibiotics. NSAID, non-steroidal anti-inflammatory.

Figure 6

Practice staff time spent on patient education and pharmacy callbacks reduced with DEXTENZA. (A) Practice staff spent 45% less time on patient education and (B) 46% less time on pharmacy calls with DEXTENZA compared to the standard of care 3-drop regimen.

Figure 7

Satisfaction of practice staff representatives with using DEXTENZA as a new means of providing 30 days of steroid treatment for patients undergoing cataract surgery. Scores are based on 7-point Likert scale with 1 being highly dissatisfied, 4 being neither dissatisfied nor satisfied, and 7 being highly satisfied. Approximately 95% of practice staff representatives were satisfied to highly satisfied.